Drug-Eluting Stent utilization in Gastrointestinal Bleeding associated with Percutaneous Coronary Intervention

Background
Drug Eluting Stent (DES) benefit in patients with gastrointestinal bleeding (GIB) is not well described. We sought to describe outcomes and procedure-related complications in patients with periprocedural GIB undergoing percutaneous coronary intervention (PCI).

Methods
Study population was derived from the HCUP-NIS database. ICD-9 codes were used to identify patients with periprocedural GIB undergoing PCI between 2008 and third quarter of 2015. Propensity score matching was used to adjust for patient and procedural confounders.

Results
Among 35,346 patients with periprocedural GIB undergoing PCI, DES was used in 18,469 (52.3%). There is an increase in use of DES for both genders from 2008 to 2015 (all patients 40.2% vs 66.5%, p<0.001; female 42.9% vs 61.1%, p<0.001; male 38.4% vs 69.3%, p<0.001) (Figure 1). DES recipients were younger (68.5 vs 69.1, p<0.0001) with a higher baseline clinical risk. All-cause mortality and blood transfusion rates were significantly lower in the DES cohort, whereas cost of hospitalization and need for peripheral ventricular assist device (PVAD) were higher. These statistically significant differences persisted after propensity score matching analysis. (Table 1)

Conclusions
DES-PCI in patients with periprocedural GIB is associated with decreased all-cause mortality and need for blood transfusions, but higher total expenses and need for PVAD compared to BMS-PCI. A significant increase in DES utilization for both genders is observed.